188948 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 364541 Page 1 of 1
ONE CIVIC SQUARE SANDRA PERRY CHECK AMOUNT: $644.00
CARMEL, INDIANA 46032 3021 ROLLING SPRINGS DR
CARMEL IN 46033 CHECK NUMBER: 188948
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4358400 473253 644.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt# 473253
Payment Date: 07/14/10
Household 3199
Monon Community Center Sandra Perry Hm Ph: (317)569 -9210
Carmel IN 46032 3021 Rolling Springs Dr
Carmel IN 46033 Cell Ph: (317)709-0990
bjohnson @carmelclayparks.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 80.00
Enrollee Name: Kate Perry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001 -17 Vacation Station 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/1212010 (Cancelled)
Class Location: Clay Middle School Class Dates: 07/12/2010 to 07/16/2010
Clay Middle School 7:00A to 6:OOP
5150 East 126th Street M,Tu,W,Th,F
Carmel, IN 46033 Scheduled Sessions: 5
(317)848 -7275
CANCELLATION Refund Of 80.00
Enrollee Name: Kate Perry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001 -18 Vacation Station 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/12/2010 (Cancelled)
Class Location: Clay Middle School Class Dates: 07/19/2010 to 07/23/2010
Clay Middle School 7:OOA to 6:OOP
5150 East 126th Street M,Tu,W,Th,F
Carmel, IN 46033 Scheduled Sessions: 5
(317)848 -7275
CANCELLATION Refund Of 80.00
Enrollee Name: Kate Perry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001 -19 Vacation Station 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/1212010 (Cancelled)
Class Location: Clay Middle School Class Dates: 07/26/2010 to 07/30/2010
Clay Middle School 7:OOA to 6:OOP
5150 East 126th Street M,Tu,W,Th,F
Carmel, IN 46033 Scheduled Sessions: 5
(317)848 -7275
CANCELLATION Refund Of 80.00
Enrollee Name: Alexandra Perry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001 -17 Vacation Station 0.00 OM 0.00 0.00 0.00
Enrollment Date: 07/12/2010 (Cancelled)
Page 1
ACTIVITY REFUND RECEIPT
Receipt 473253
Payment Date: 07/14/2010
Household 3199
Class Location: Clay Middle School Class Dates: 07/12/2010 to 07/16/2010
Clay Middle School 7:OOA to 6:OOP
5150 East 126th Street M,Tu,W,Th,F
Carmel IN 46033 Scheduled Sessions: 5
(317)848 -7275
CANCELLATION Refund Of 80.00
Enrollee Name: Alexandra Perry Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476001 -18 Vacation Station 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 07/12/2010 (Cancelled)
Class Location: Clay Middle School Class Dates: 07/19/2010 to 07/23/2010
Clay Middle School 7:OOA to 6-OOP
5150 East 126th Street M,Tu,W,Th,F
Carmel IN 46033 Scheduled Sessions 5
(317)848 -7275
PREVIOUS NET CREDIT HOUSEHOLD BALANCE 244.00
Processed on 07114/10 15:29:37 by BJJ FEES ADJUSTED ON CHANGED ITEMS 400.00
NET AMOUNT FROM :CHANGED•ITEMS, 4000Or.;
HH BALANCE APPLIED TO THIS RECEIPT 244.00
FTOTAL AM0UNT'REFUNpEr3- 644:00,
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 644.00 Made By REFUND FINAN With Reference
All refunds ar subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No -cmh or credit card refunds.
-7 r �1
Auth &d nature Date Authorized Signature Date
1 4 4--j Skcv
V Page #2
ACCOUNTS PAYABLE VOUCHER
o CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Perry, Sandra Terms
3021 Rolling Springs Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7114110 473253 Refund 644.00
Total 644.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No,
Perry, Sandra Allowed 20
3021 Rolling- Springs Dr
Carmel, IN 46033
In Sum of
a
644.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 473253 4358400 644.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
12 -Aug 2010
Signature
644.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund